超声脐血流S/D比值联合可溶性CD40配体及热休克蛋白70对妊娠期高血压患者母婴结局的预测

The predictive value of ultrasound umbilical cord blood flow S/D ratio combined with serum soluble CD40 ligand and heat shock protein 70 for maternal and fetal outcomes in patients with gestational hypertension

目的探讨超声脐血流收缩末期峰值(S)与舒张末期峰值(D)的比值(S/D)联合血清可溶性CD40配体(sCD40L)、热休克蛋白70(HSP70)对妊娠期高血压母婴结局的预测价值。方法回顾性分析2020年6月至2022年6月于保定第一中心医院诊治的160例妊娠期高血压患者临床资料。根据母婴结局将患者分为母婴结局正常组(n=120)和母婴结局异常组(n=40)。所有患者均行超声检查脐血流S/D比值;酶联免疫吸附(ELISA)法测定患者血清中sCD40L、HSP70水平;对影响妊娠期高血压母婴结局的因素进行Logistic回归分析;受试者工作特征(ROC)曲线分析超声脐血流S/D比值联合血清sCD40L、HSP70对妊娠期高血压母婴结局的预测价值。结果与母婴结局正常组比较,异常组妊娠期高血压患者超声脐血流S/D比值显著升高(3.86±1.01 vs 2.57±0.65,P<0.05),血清sCD40L[(3.65±0.91)ng/L vs(6.04±1.42)ng/L]、HSP70水平[(2.01±0.46)μg/L vs(2.90±0.52)μg/L]均明显升高(P<0.05);Logistic回归分析发现,超声脐血流S/D比值、sCD40L、HSP70是影响妊娠期高血压患者母婴结局的危险因素(P<0.05)。超声脐血流S/D比值联合血清sCD40L、HSP70预测妊娠期高血压母婴结局的ROC曲线下面积(AUC)为0.993,均优于其各自单独预测(Z三者联合-超声脐血流S/D比值=4.030,P<0.001;Z三者联合-sCD40L=2.409,P=0.008;Z三者联合-HSP70=4.302,P<0.001)。结论妊娠期高血压患者超声脐血流S/D比值、血清sCD40L、HSP70水平升高,且与母婴结局有关,临床可用以预测患者母婴结局。

Objective To explore the predictive value of the ratio of end systolic peak(S)to end diastolic peak(D)(S/D)of ultrasound umbilical blood flow combined with serum soluble CD40 ligand(sCD40L)and heat shock protein 70(HSP70)on maternal and fetal outcomes of pregnancy induced hypertension.Methods Retrospective analysis was carried out on the total of 160 patients with pregnancy induced hypertension who were treated in Baoding First Central Hospital from June 2020 to June 2022,and they were grouped into 120 patients in normal maternal and infant outcomes group and 40 patients in abnormal maternal and infant outcomes group according to the maternal and infant outcomes.The S/D ratio of umbilical blood flow was examined by ultrasound in all patients;the serum levels of sCD40L and HSP70 were measured by enzyme-linked immunosorbent assay(ELISA);Logistic regression analysis was carried out on the factors affecting the maternal and infant outcomes of pregnancy induced hypertension;receiver operating characteristic(ROC)curve was used to analyze the predictive value of ultrasound umbilical blood flow S/D ratio combined with serum sCD40L and HSP70 for maternal and infant outcomes of pregnancy induced hypertension.Results Compared with the normal maternal and infant outcomes group,the S/D ratio of ultrasound umbilical blood flow in the abnormal maternal and infant outcomes group was obviously higher(3.86±1.01 vs 2.57±0.65,P<0.05),the levels of serum sCD40L[(6.04±1.42)ng/L vs(3.65±0.91)ng/L]and HSP70[(2.90±0.52)μg/L vs(2.01±0.46)μg/L]were obviously higher(P<0.05);Logistic regression analysis showed that the S/D ratio of ultrasound umbilical blood flow,sCD40L and HSP70 were risk factors affecting the maternal and infant outcomes of pregnancy induced hypertension(P<0.05).The area under the ROC curve(AUC)of ultrasound umbilical cord blood flow S/D ratio combined with serum sCD40L and HSP70 to predict the maternal and infant outcomes of pregnancy induced hypertension was 0.993,better than their respective independent prediction(Z-combinations of the three-ultrasound umbilical cord blood flow S/D ratio=4.030,P<0.001;Z-combinations of the three-sCD40L=2.409,P=0.008;Z-combinations of the three-HSP70=4.302,P<0.001).Conclusion The S/D ratio of umbilical cord blood flow,increased serum sCD40L and HSP70 levels in patients with pregnancy induced hypertension are related to the maternal and infant outcomes,which can better predict the maternal and infant outcomes.